Lundqvist Eva, Fischer Per, Wretenberg Per, Pettersson Kurt, Lopez Personat Adolfo, Sagerfors Marcus
Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Hand Surgery, Örebro University Hospital, Örebro, Sweden.
Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Orthopedics, Karlstad Central Hospital, Karlstad, Region Värmland, Sweden.
J Hand Surg Am. 2022 Sep;47(9):813-822. doi: 10.1016/j.jhsa.2022.04.018. Epub 2022 Jul 13.
The optimal way to stabilize intra-articular distal radius fractures is unclear despite recent advances in surgical management. Volar plating is the most common treatment but may not be sufficient for more complex intra-articular AO type C fractures. The purpose of this randomized controlled study was to evaluate the radiographic and clinical outcomes following surgical treatment of AO type C distal radius fractures, comparing volar with combined plating.
In this study, 150 patients were randomized to volar locking plate (n = 75) or combined plating (n = 75) following a distal radius fracture AO type C. The 1-year follow-up included radiographic outcome (Batra score), visual analog scale pain score, hand grip strength, wrist range of motion, Patient-Rated Wrist Evaluation score, and Quick Disabilities of the Arm, Shoulder, and Hand score.
Overall, 147 patients (median age 61 years) completed the 1-year follow-up (73 patients with volar plate and 74 with combined plating). No difference was found in radiographic outcome between the treatment groups. The volar plate group had significantly better Patient-Rated Wrist Evaluation scores, Quick Disabilities of the Arm, Shoulder, and Hand scores, hand grip strength, visual analog scale scores during activity, and flexion, extension, ulnar and radial deviation than the combined plate group. Hardware removal was performed in 10% in the volar plate group and in 31% in the combined plate group. There was no postoperative infection in the volar plate group but 3 cases in the combined plate group.
In patients with complex AO type C intra-articular fractures, volar and combined plating yielded the same radiographic result. The differences in Patient-Rated Wrist Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand scores between the groups did not reach the thresholds for minimal clinically important differences, suggesting similar clinical outcome. The combined plating group had a considerably higher frequency of hardware removal and postoperative infections.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
尽管手术治疗近期取得了进展，但桡骨远端关节内骨折的最佳稳定方法仍不明确。掌侧钢板固定是最常见的治疗方法，但对于更复杂的关节内AO C型骨折可能并不足够。本随机对照研究的目的是评估AO C型桡骨远端骨折手术治疗后的影像学和临床结果，比较掌侧钢板固定与联合钢板固定。
在本研究中，150例AO C型桡骨远端骨折患者被随机分为掌侧锁定钢板组（n = 75）和联合钢板固定组（n = 75）。1年随访包括影像学结果（巴特拉评分）、视觉模拟量表疼痛评分、握力、腕关节活动范围、患者自评腕关节评估评分以及手臂、肩膀和手部快速残疾评分。
总体而言，147例患者（中位年龄61岁）完成了1年随访（73例接受掌侧钢板固定，74例接受联合钢板固定）。治疗组之间的影像学结果无差异。掌侧钢板组在患者自评腕关节评估评分、手臂、肩膀和手部快速残疾评分、握力、活动时视觉模拟量表评分以及屈伸、尺偏和桡偏方面均显著优于联合钢板组。掌侧钢板组10%的患者进行了内固定取出，联合钢板组为31%。掌侧钢板组无术后感染，联合钢板组有3例。
在复杂的AO C型关节内骨折患者中，掌侧钢板固定和联合钢板固定产生了相同的影像学结果。两组之间患者自评腕关节评估和手臂、肩膀和手部快速残疾评分的差异未达到最小临床重要差异的阈值，表明临床结果相似。联合钢板组内固定取出和术后感染的频率明显更高。
研究类型/证据水平：治疗性I级
